New Developments in Dementia Treatment

For those who live with it, dementia can be devastating. But year by year, new drugs, technologies and techniques are being developed that not only reduce the likelihood of the condition occurring in the first place, but are also more effective in helping manage it if it does. This means that in terms of alleviating symptoms and slowing the progress of different types of dementia, doctors now have more treatment options than was thought possible, even just a few years ago.

These developments can involve looking at new ways to use existing drugs. For example, an American study has shown that beta-blockers, which are traditionally used to treat high blood pressure, might also be effective in lessening the onset of dementia. At the moment, because of the small size of the research sample, beta-blockers, can't as yet be prescribed for this purpose. However, a much larger study involving another type of blood pressure reducing drug, known as angiotensin receptor blocker (ARB), has been shown to have a similar benefits, which could lead to new range of medications becoming available.

Several other promising treatments are also in the late phases of testing. These include a drug that blocks the build-up of amyloid (the lumps of protein that can stop neurones in the brain from working properly together), while another is aimed at preventing the clumping of tau protein, a primary indicator of Alzheimer's. Initial results suggest that both could be effective lines of research.

While at the Massachusetts Institute of Technology (MIT) after 15 years of work, scientists have created 'Souvenaid'. This is a once-a-day drink they have developed to repair the damage done to neurones at the synapses, the point where they connect with each other in our brains. Tests have shown that Souvenaid does seem to help improve the memory of dementia sufferers.

Correct diagnosis of the exact nature and type of the dementia is of course important in the early stages of the disease if the best treatments are be given. In the past this could often involved some form of invasive treatment such as lumbar puncture. But now, American researchers have found that MRI scans can be used effectively in diagnosis, which means much less trauma for patients.

For younger sufferers in particular, being diagnosed with dementia can lead to the loss of employment and their independence. So in Hull, a two-year long pilot project is underway that will give those suffering from dementia the opportunity, with the support of a personal mentor, to do voluntary work in their own community. This positive and forward-thinking scheme will help demonstrate that those suffering from Alzheimer's and similar diseases are still able to make a contribution to society.

With other on-going trials of medications normally used in the treatment of high blood pressure and diabetes, as well as statins and even some antibiotics, there are definite signs that the light at the end of the tunnel is beginning to shine brighter for those suffering from the debilitating effects of dementia.

If you or someone you love is experiencing early signs of dementia, find out about the specialist dementia care options available to you.

What Housework Has to Do With Waistlines

Justin Pumfrey/Getty Images Gretchen Reynolds on the science of fitness.

One reason so many American women are overweight may be that we are vacuuming and doing laundry less often, according to a new study that, while scrupulously even-handed, is likely to stir controversy and emotions.

The study, published this month in PLoS One, is a follow-up to an influential 2011 report which used data from the U.S. Bureau of Labor Statistics to determine that, during the past 50 years, most American workers began sitting down on the job. Physical activity at work, such as walking or lifting, almost vanished, according to the data, with workers now spending most of their time seated before a computer or talking on the phone. Consequently, the authors found, the average American worker was burning almost 150 fewer calories daily at work than his or her employed parents had, a change that had materially contributed to the rise in obesity during the same time frame, especially among men, the authors concluded.

But that study, while fascinating, was narrow, focusing only on people with formal jobs. It overlooked a large segment of the population, namely a lot of women.

“Fifty years ago, a majority of women did not work outside of the home,” said Edward Archer, a research fellow with the Arnold School of Public Health at the University of South Carolina in Columbia, and lead author of the new study.

So, in collaboration with many of the authors of the earlier study of occupational physical activity, Dr. Archer set out to find data about how women had once spent their hours at home and whether and how their patterns of movement had changed over the years.

He found the information he needed in the American Heritage Time Use Study, a remarkable archive of “time-use diaries” provided by thousands of women beginning in 1965. Because Dr. Archer wished to examine how women in a variety of circumstances spent their time around the house, he gathered diaries from both working and non-employed women, starting with those in 1965 and extending through 2010.

He and his colleagues then pulled data from the diaries about how many hours the women were spending in various activities, how many calories they likely were expending in each of those tasks, and how the activities and associated energy expenditures changed over the years.

As it turned out, their findings broadly echoed those of the occupational time-use study. Women, they found, once had been quite physically active around the house, spending, in 1965, an average of 25.7 hours a week cleaning, cooking and doing laundry. Those activities, whatever their social freight, required the expenditure of considerable energy. (The authors did not include child care time in their calculations, since the women’s diary entries related to child care were inconsistent and often overlapped those of other activities.) In general at that time, working women devoted somewhat fewer hours to housework, while those not employed outside the home spent more.

Forty-five years later, in 2010, things had changed dramatically. By then, the time-use diaries showed, women were spending an average of 13.3 hours per week on housework.

More striking, the diary entries showed, women at home were now spending far more hours sitting in front of a screen. In 1965, women typically had spent about eight hours a week sitting and watching television. (Home computers weren’t invented yet.)

By 2010, those hours had more than doubled, to 16.5 hours per week. In essence, women had exchanged time spent in active pursuits, like vacuuming, for time spent being sedentary.

In the process, they had also greatly reduced the number of calories that they typically expended during their hours at home. According to the authors’ calculations, American women not employed outside the home were burning about 360 fewer calories every day in 2010 than they had in 1965, with working women burning about 132 fewer calories at home each day in 2010 than in 1965.

“Those are large reductions in energy expenditure,” Dr. Archer said, and would result, over the years, in significant weight gain without reductions in caloric intake.

What his study suggests, Dr. Archer continued, is that “we need to start finding ways to incorporate movement back into” the hours spent at home.

This does not mean, he said, that women — or men — should be doing more housework. For one thing, the effort involved is such activities today is less than it once was. Using modern, gliding vacuum cleaners is less taxing than struggling with the clunky, heavy machines once available, and thank goodness for that.

Nor is more time spent helping around the house a guarantee of more activity, over all. A telling 2012 study of television viewing habits found that when men increased the number of hours they spent on housework, they also greatly increased the hours they spent sitting in front of the TV, presumably because it was there and beckoning.

Instead, Dr. Archer said, we should start consciously tracking what we do when we are at home and try to reduce the amount of time spent sitting. “Walk to the mailbox,” he said. Chop vegetables in the kitchen. Play ball with your, or a neighbor’s, dog. Chivvy your spouse into helping you fold sheets. “The data clearly shows,” Dr. Archer said, that even at home, we need to be in motion.

Gretchen Reynolds on the science of fitness.

Depression May Stifle Shingles Vaccine Response

Depression may lower the effectiveness of the shingles vaccine, a new study found.

The research showed that adults with untreated depression who received the vaccine mounted a relatively weak immune response. But those who were taking antidepressants showed a normal response to the vaccine, even when symptoms of depression persist.

Shingles, an acute and painful rash, strikes a million Americans each year, mostly older adults. Health officials recommend that those over 60 get vaccinated against the condition, which is caused by reactivation of the same virus that causes chickenpox, varicella-zoster.

In the new study, published in the journal Clinical Infectious Diseases, researchers followed a group of 92 older men and women for two years. Forty of the subjects had a major depressive disorder; they were matched with 52 control subjects of similar age. The researchers measured their immune responses to the shingles vaccine and a placebo shot.

Compared with the control patients, those with depression were poorly protected by the vaccine. But the patients who were being treated for their depression showed a boost in immunity — what the researchers called a “normalization” of the immune response. It is unclear why that was the case.

The authors of the study speculated that treatment of older people with depression might increase the effectiveness of the flu shot and other vaccines as well.

Ask Well: Exercises for Shoulder Pain

You are certainly right that sore shoulders are common, especially as a person ages. About half of all middle-aged tennis players suffer from shoulder pain, according to a 2012 study in The British Journal of Sports Medicine, and youngsters aren’t immune either. The same study reported that about a quarter of competitive tennis players under 20 hurt their shoulders every year.

Many of these injuries involve the rotator cuff, the group of muscles and tendons at the back of the shoulder that stabilize the joint. Studies show that forces equivalent to at least 120 percent of a person’s body weight slam through the rotator cuff during a typical tennis serve or baseball pitch. To withstand that pounding, the rotator cuff needs to be strong.

But many of us, including tennis players, have relatively weak rotator cuff muscles. “Playing tennis builds up the muscles in the front of the shoulder, but it doesn’t build up those in the back very much,” says Todd Ellenbecker, the clinic director at Physiotherapy Associates Scottsdale Sports Club in Scottsdale, Ariz., and senior director of medical services for the ATP World Tour, the men’s professional tennis circuit.

To isolate and strengthen the rotator cuff, Mr. Ellenbecker recommends simple exercises that you can do at home and that require only a stretchy exercise band or length of elastic tubing and a rolled-up towel. You can find step-by-step instructions for a number of these exercises, which Mr. Ellenbecker prescribes for professional tennis players, at “How to Fix a Bad Tennis Shoulder.”

Don’t wait to start the program, by the way, until your shoulders ache. “These exercises are excellent for preventing shoulder injuries,” Mr. Ellenbecker said, “in addition to rehabilitating injured shoulders.”

But of course, don’t start the program without first consulting a doctor, especially if you have shoulder pain. “See an orthopedic surgeon,” Mr. Ellenbecker said, “to have the shoulder carefully evaluated and maybe X-rayed to rule out injuries” more severe than a strained rotator cuff, he said.

Omega-3s May Lead to Healthier Babies

Pregnant women who took daily supplements of DHA, a type of omega-3 fatty acid, had longer gestations, bigger babies and fewer early preterm births, according to a new clinical trial.

In the double-blinded study, published online in The American Journal of Clinical Nutrition, researchers randomly assigned 154 healthy women to take 600 milligrams of DHA during the last half of pregnancy and 147 to take a placebo.

After adjusting for maternal education, socioeconomic status, prior pregnancy, smoking and other risk factors, they found that babies whose mothers took supplements were almost a half pound heavier than those of the mothers who took none, and they were slightly longer with larger head circumferences.

Almost 5 percent of mothers who took the placebo gave birth at 34 weeks’ gestation or less, compared with only 0.6 percent of the mothers who took DHA.

The lead author, Susan E. Carlson, a professor of nutrition at the University of Kansas, pointed out that the incidence of low birth weight and gestation shorter than 34 weeks in the placebo group is very similar to rates in the general population, while the DHA group had dramatic reductions. There were no adverse effects to taking the supplements.

Although a larger study is needed, she said, “women should be having a conversation with their doctors about whether they should be taking DHA during pregnancy.”

No Vitamin D and Calcium for Older Bones

A government task force formally recommended on Monday that healthy postmenopausal women avoid taking low daily doses of vitamin D and calcium to ward off bone fractures.

The group, the United States Preventive Services Task Force, an independent panel of experts in prevention and primary care, based its recommendations on extensive reviews of more than a hundred studies. They characterized low doses as 400 international units or less of vitamin D and 1,000 milligrams or less of calcium.

Taking those amounts daily, the task force wrote in its recommendations, “has no net benefit for the primary prevention of fractures.” But there is good evidence, the group said, that taking them could increase the likelihood of kidney stones.

The task force also looked at the use of the supplements in men and premenopausal women. The group concluded it was unable to “assess the balance of the benefits and harms” of using the supplements to prevent fractures in these groups.

The recommendations, however, do not apply to people with osteoporosis or vitamin D deficiencies, the task force said.

PMS Symptoms Linked to Diet

A 10-year study of more than 3,000 women has found that dietary iron may reduce the risk for premenstrual syndrome, while potassium intake may increase it.

Using data from a larger analysis of women’s health, researchers studied 1,057 women with PMS and 1,968 control subjects. They used questionnaires to establish their nutrient intake, both food and supplements, and established cases of PMS by clinical diagnosis.

After controlling for various health and dietary factors, they found that women in the highest 20 percent for iron intake were about 40 percent less likely to suffer PMS as those in the lowest 20 percent.

The study, published online in The American Journal of Epidemiology, found the opposite effect with potassium. Those in the highest 20 percent of intake had a 46 percent increased risk for PMS compared with those in the lowest 20 percent. There was no risk associated with intake of magnesium, zinc, manganese, copper or sodium.

The senior author, Elizabeth R. Bertone-Johnson, an associate professor of epidemiology at the University of Massachusetts, cautioned women against taking too much iron, or consuming too little potassium, both of which can be harmful. “Eating a balanced diet with a variety of foods,” she said, “is a good way to ensure that women are consuming important vitamins and minerals.”

The Food and Nutrition Board of the Institute of Medicine recommends 18 milligrams of iron daily for women 19 to 50, and 4,700 milligrams of potassium a day for all adults.